Task force unsure whether early autism screening beneficial

Experts said studies on the accuracy of screenings and the efficacy of early intervention among children younger than 30 months old are too inconsistent to make a recommendation.
By Stephen Feller  |  Feb. 16, 2016 at 2:13 PM
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ROCKVILLE, Md., Feb. 16 (UPI) -- The U.S. Preventive Services Task Force is unsure whether autism screening for young children is beneficial or harmful, according to a new recommendation statement from the agency.

The USPSTF said it would not recommend for or against the early screenings for autism spectrum disorder between the ages of 18 and 30 months because of a lack of quality research on the outcomes of screening for children who receive an early diagnosis.

Autism spectrum disorder, or ASD, screening between the ages of 18 and 30 months is often conducted without a parent, doctor or caregiver expressing a concern about developmental delays. As of 2010, ASD in the United States was estimated to be at 14.7 cases per 1000 children, or 1 of every 68 children.

In the new recommendation, researchers found a dearth of evidence for the benefits of early intervention with children of these ages.

"The task force found we need more research to understand whether screening very young children who don't have obvious symptoms for autism benefits them in the long-term," said Dr. David Grossman, vice chairman of the USPSTF. "We need to know more about the best age to screen, the best method to use, and weather screening all children ultimately improves their quality of life."

Studies of initial screening processes showed they positively predicted a diagnosis about half the time, and one study found a group of children screened but not diagnosed with ASD nearly all had another type of developmental delay. None of these studies indicated the outcome of diagnosis, researchers wrote in the recommendation, which is published in the Journal of the American Medical Association.

The researchers found no studies that showed improvements to ASD symptoms in children 3 years old or younger. They also found results in 26 randomized clinical trials for cognitive, speech and social interventions were inconsistent.

Although no specific harms were noted among children screened or entered into some form of therapy, stress related to screening and diagnosis, as well as time and financial burdens, were acknowledged as having a "no greater than small" potential for harm.

In an editorial on the recommendation published alongside it in JAMA, pediatric researchers from the schools of medicine at the University of Michigan and Boston University say that while some may question if harm from screening is possible, considering the medical necessity of any test is part of providing appropriate medical services.

"In considering the USPSTF's recommendation, the issue of 'direct evidence' is critical," the researchers write. "Although validation studies might prove a screening test to be good at identifying a certain condition, and separate interventional studies might show improvement in those treated for that condition, this piecemeal analytic framework demonstrates only the strength of individual links in a complicated process chain that includes screening, diagnostic evaluation, engagement with treatment, and improved health outcomes."

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